Incretin-based therapies in peri- and postmenopausal women with obesity: an expert position statement from the Spanish Menopause Society.

This position statement provides a focused framework for integrating incretin-based therapies into the care of peri- and postmenopausal women with overweight or obesity, with emphasis on body composition, cardiometabolic risk, musculoskeletal health, monitoring, and menopause hormone therapy. MenoYoung Spain, the Young Investigators Group of the Spanish Menopause Society, coordinated a structured literature review and iterative expert review process with senior Spanish Menopause Society experts. MEDLINE, Embase, and the Cochrane Library were searched through April 30, 2026 for studies evaluating glucagon-like peptide-1 receptor agonists and dual incretin therapies in peri- or postmenopausal women, menopause-stratified populations, and clinically relevant broader obesity populations. Evidence was synthesized narratively across predefined clinical domains, and 20 position statements were developed and reviewed by all authors. Semaglutide currently provides the largest amount of direct menopause-specific evidence among incretin-based therapies, although this evidence remains limited and largely observational. Tirzepatide and other dual incretin therapies are clinically promising, particularly for cardiometabolic disease and obstructive sleep apnea, but require menopause-specific evaluation. The association between concomitant use of menopause hormone therapy and greater semaglutide-related weight loss remains hypothesis-generating and should not justify initiating hormone therapy solely to augment weight loss. Incretin-based therapy in menopause should be considered within a cardiometabolic and functional framework that incorporates visceral adiposity, skeletal muscle health, fracture risk, cardiovascular prevention, individualized hormone therapy decision-making, resistance exercise, adequate protein intake, and structured monitoring of functional and metabolic outcomes.